Dangerous Leadership and a Culture of Violence

Shared Psychosis in the Age of Donald Trump

[Below is a personal copy, at the public’s request, of my article published in Cultura & Psyché: Journal of Cultural Psychology, https://doi.org/10.1007/s43638-023-00078-y.]

Abstract

In 2017, as soon as Donald Trump took the US presidency, a group of distinguished psychiatrists mobilized in the USA to warn that psychological dangers in an influential office would result in social, cultural, and geopolitical dangers—years later, their warnings prove to be prescient. The spectacular rise of a psychologically dangerous figure, as well as many like him throughout the world, cannot be fully explained without examination of the concept of contagion that results in shared psychosis. This paper outlines the phenomenological manifestations and the conditions for the spread of a shared psychosis, or folie à millions, and how they apply to national and international politics in an era when dangerous, mentally impaired leaders are posing a public mental health risk. The importance of a robust psychological discourse and public education about psychodynamics at play in larger society, in the midst of a collective mental health crisis, is emphasized.

In 2017, as soon as Donald Trump took the US presidency, the author and a distinguished group of psychiatrists came together to hold a conference at Yale School of Medicine to discuss the unprecedented risk of having the most dangerously psychologically impaired president to have ever assumed the authority and influence of the office, with command over the world’s most powerful military and the world’s second largest nuclear arsenal (Lee 2017b). They believed that they had a civic and professional responsibility to share their concerns of how having a manifestly unfit, fascistic authoritarian would endanger the public through massively spreading violence (Kendall 2022). This led to their public-service book, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President (Lee 2017a), which was published later that year.

The book became an instant New York Times bestseller, and within 3 months they were the number one topic of national conversation. Distinguished journalists believed that they would be the key to bringing about a much-needed resolution to a national problem, and chairs of psychiatry from all around the country reached out to congratulate them. The authors were invited to meet with over 50 US Congress members, who seriously contemplated the Twenty-Fifth Amendment (U.S. Const. amend. 25)—a political process of removing a president who “is unable to discharge the powers and duties of his office”—as well as various other interventions (Karni 2018). The US Congress depended on the ability of the psychiatric experts to “educate the public medically,” so that they could “act politically.” Unfortunately, the federally funded and pharmaceutical industry-dependent American Psychiatric Association (APA) took a different position (APA 2017).

It tightened its “Goldwater rule” to turn it into a “gag order,” and declared that psychiatrists had no societal responsibility (Martin-Joy 2020)—even though “responsibility to ... society” is codified into its own ethical guidelines (APA 2013b). Furthermore, both science and practice had gradually diminished the relevance of “the Goldwater rule” over decades (Lilienfeld et al. 2018). Nevertheless, the APA actively intervened and excluded all mental health experts, not just its members, from the media through an aggressive media campaign (APA 2018). National politics may have taken a difference course, had the nominally professional association not acted as an arm of the Trump administration (Lee 2021).

Meanwhile, thousands of mental health professionals joined the authors (Goodman 2017), and the newly formed organization, the World Mental Health Coalition (WMHC), held in 2019 in the main ballroom of the National Press Club of Washington, DC, its most significant public event, “The Dangerous State of the World and the Need for Fit Leadership.” It gathered together as never before the country’s leading scholars from history and political science to climate science and nuclear science, as well as the former chief White House ethics lawyer of the Bush/Cheney Administration, Richard Painter; the psychiatrist who established the department of psychological profiling for the US Central Intelligence Agency, Jerrold Post; and a Maryland representative from the US Congress, Jamie Raskin. They collectively warned that uncontained psychological dangers in the US presidency would soon spread to social, cultural, geopolitical, and civic dangers (Lee et al. 2019).

At the onset of the COVID-19 pandemic, the WMHC started warning against a “mental health pandemic” and issued its first “Prescription for Survival,” immediately following the announcement of the pandemic in the USA, in March 2020 (WMHC 2020b). Had their “Prescription” been followed, hundreds of thousands of lives may have been saved in the USA alone (Woolhandler et al. 2021).

That summer, the author wrote Profile of a Nation: Trump’s Mind, America’s Soul (Lee 2020a), which stated that Donald Trump “will likely refuse to concede the results, call the election a fraud, and refuse to leave office.” Indeed, after the election 5 months later, that is what happened. In the book, the author warned that, as a result, the Trump presidency would not end with an election and had the danger to continue to threaten the world until there was commensurate intervention for the actual problems: his psychopathology and criminality. The author made this assertion because of the psychic contagion Donald Trump had spread (Moyers 2021)—conditioning the minds of his followers to accept extreme distortions of reality. This led to extreme actions, including the violent attack on the US Capitol on 6 January 2021, as a manifestation of “shared psychosis” (Lewis 2021).

1 Shared Psychosis

In current nosology, “shared psychosis,” much like “narcissism” (as opposed to “narcissistic personality disorder”), is a psychosocial phenomenon rather than a diagnosis, which is not as rare as previously believed (Greener 2007). “Shared psychotic disorder” as an individual diagnosis appeared in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (APA 1994), but has been replaced by “induced delusional disorder” for both the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (APA 2013a) and the International Classification of Diseases, Eleventh Revision (ICD-11) (World Health Organization 2019).

The concept first appeared in 1860, when Jules Baillarger reported “folie communiquée” (communicated psychosis) in France. Lehman and Sharfetter called it “Induziertes Irresein” (induced insanity) in Germany. Charles Lasègue and Jules Falret coined the diagnosis, “folie à deux” (madness by two) in 1877. Gralnick reviewed 103 cases and structured them into four subtypes in the USA: “folie imposée” (induction in a previously healthy person); “folie induite” (induction in a predisposed person); “folie communiquée” (induction after overcoming resistance); and “folie simultanée” (mutual induction of concurrent illness) (Al Saif and Al Khalili 2022). The same phenomenon on a societal scale has been described in Gustave Le Bon’s (1895) The Crowd, in Carl Jung’s (1954) The Symbolic Life, and in Sigmund Freud’s (1930) Civilization and Its Discontents, before Erich Fromm (1955) coined the phrase, “folie à million,” in The Sane Society.

2 Psychic Contagion

So how does the spread of mental symptoms happen? Contagion was of concern to the mental health experts who put together the monograph, The Dangerous Case of Donald Trump (Lee 2017a). Framing the Trump presidency as a public health problem and a societal threat from the start, they warned that if his presidency were not intervened with swiftly and properly, his symptoms—his paranoia, delusions, and tendency toward violence—would spread from his powerful office to become uncontainable (Lee 2018). This is because mental symptoms are by nature psychosocial, driven by emotional compulsion and traveling along bonds of affection. They noted with the onset of the COVID-19 pandemic that the more important, underlying pandemic in need of control was what they called a “mental health pandemic” (Lee 2020b). In other words, his compromise of the nation’s collective mental health constituted a “psychic pandemic” that was just as virulent as the viral pandemic (Di Renzo and Tagliacozzi 2021). It was responsible, furthermore, for vastly exacerbating the viral pandemic (Kapucu and Moynihan 2021).

A large percentage of the 7 million deaths around the world (World Health Organization 2023) may be traced back to Donald Trump, who was the greatest source of the world’s misinformation on COVID-19 (Evanega et al. 2020), at a time when education was the primary defense against the disease, in the absence of vaccines or treatment. Trump was also responsible for pulling out a key infectious disease expert and an entire team out of China, just months before the outbreak, not to mention depleting the US Centers for Disease Control and Prevention (CDC) (Devi 2020). Historically, the World Health Organization (WHO) had greatly relied on the CDC to contain global epidemics (Lancet 2020).

The same held true for political dysfunction. Compounding a poor state of collective mental health was denial (Chervet 2021), such that those who are the most affected were the least likely to admit that anything was wrong (Jorm 2011). Furthermore, psychological violence on a large scale—through repetitive lying, disinformation, and mental manipulation—can be more dangerous than physical violence, for it usurps the very mind that is capable of protecting oneself, in addition to stimulating physical violence (WMHC 2020a). Once Donald Trump had been allowed to continue in office, psychological symptoms came to be weaponized as a valid means of “winning” in politics.

Psychic contagion is most commonly observed where there are high concentrations of severe mental disturbances that go untreated, such as in public hospitals and in prisons. Severe symptoms may spread among family members (Albert et al. 2017), criminal co-conspirators, fellow gang members, and other tight-knit groups (Guivarch et al. 2018). Similar conditions were created for a nation, with a highly symptomatic “leader” figure with vast, continuous exposure to his personality cult. At the WHO, Gary Slutkin and colleagues (2015) have been successful in modeling violence as an “infectious disease” in order to interrupt its spread. Similarly, international terrorism (Midlarsky et al. 1980), suicides (Joiner 1999), and mass shootings (Kissner 2016) have been found to be subject to contagion.

3 Necessary Conditions for Contagion

Three conditions emerge as necessary for the spread of mental symptoms:

The first condition for spread is severe pathology in an influential figure Severe psychopathology in a dominant figure can cause a spread of symptoms. The phenomenon can be named after the number of people affected: “folie à deux, trois, quatre ...” When the afflicted persons become too numerous, however, it can become “folie à millions”—or mass hysteria (Blackman andWalkerdine 2017). ICD-11 (WHO 2019) and DSM-5 (APA 2013a) currently focus on the most commonly transmitted symptom, delusions, referring to “induced delusions,” but this nomenclature does not cover other symptoms, such as illusions, hallucinations, or mood. “Shared psychosis” captures the syndrome-like quality, but can be mistakenly equated with “psychosis,” and psychosis (loss of touch with reality) is not required for shared psychosis. “Mass hysteria” describes well the frenzied irrationality that captures crowds, but again confusion can occur with “hysteria” or “histrionics,” when histrionics (dramatic behavior) are not a required symptom. This article will stay with “shared psychosis,” to emphasize the severity and the syndrome-like quality, when it affects the masses.

The “shared” feature emphasizes the psychosocial nature of mental symptoms (Sacks 1988). They take hold and then spread across interpersonal connections, much as they initially take over one portion, and then eventually the whole mind of an individual. Intrapersonal conflicts turn into interpersonal ones. When the symptoms transmit from the primary person to others and to entire groups, the exposed persons or groups come to feel, think, and behave as if they had the same disorder as the primary person (Harrington 1982). Unlike ordinary emotions that become “infectious,” such as laughter, enthusiasm, and even outrage, the spread of pathology is more efficient and deleterious, appropriating entire personalities.

Transmission is rapid and pervasive when the primary person is an influential figure with vast exposure to the public via modern media and social media channels (Ibrahim 2003). The most likely to succumb are predisposed individuals, but eventually anyone is vulnerable. Even bizarre beliefs, such as the primary person being “God-ordained,” can take hold in ordinarily rational persons under the right conditions (Burke 2019). Delusions are more infectious than strategic lies or mistaken misinformation, because the primary person truly believes in them and is driven to affirm them through propagation of their false beliefs (Post 2015). For example, when an influential figure is pathologically driven to believe that a serious viral pandemic is a “hoax” (Franck 2020), orchestrated by enemies to bring down one’s presidency, or that a reelection one has lost is in fact “stolen” (Gross 2022), the underlying emotional process is difficult if not impossible to correct with evidence or a presentation of facts (Greenberg 2022).

The second condition for transmission is emotional bonds Another condition for the spread of mental symptoms is emotional bonds (Kovacevic et al. 2022). Folie à deux describes shared madness within a pair, such as a married couple or co-conspirators in crime, but here the focus is on folie à groupe, or the spread of shared symptoms in a group. The group can be a household (folie à famille), a prison dormitory or cell-block, a religious or other highly emotionally bonded group, a community, or a nation. Members may have tight emotional bonds with the dominant, primary person because of a family relationship, gang affiliation, cultic programming, or societal identity (Singh and Sharan 2022). Pathology in the primary individual can further condition followers for transmission: a compulsion to “tweet,” a desire to deny reality, intolerance of uncertainty, pressures for conformity, and an insatiable need for adulation finding a “forum” in addiction-inducing, hypnotic rallies (Benko 2020).

Induced delusions function in an identical manner to primary delusions, equally impervious to evidence or truth. In a group situation, those who try to maintain their grounding in reality experience stress, anxiety, ostracism, and exhaustion and may eventually submit. Eventually, when the delusions take over an entire culture, they may become characteristic of a “cultural disorder” (WMHC 2020c).

The third condition for spread is an environment that fosters contagion Social isolation, either physically with the primary individual or functionally through filtered information—for example, “immunization” against alternative viewpoints through phrases such as “fake news”—constitutes a condition that facilitates shared delusions (Silveira and Seeman 1995). Continuous, high-level exposure over a long period of time, especially under stress, adds to the ideal environment for transmission (Arnone et al. 2006).

The cult-like quality of the leader–follower arrangement between Donald Trump and his supporters caused mental health professionals to write volumes (Lifton 2019; Post 2019). “Viral” social media, “news” programs that spread propaganda for profit, and rallies that reinforce herd mentality and conformity, all comprise an environment conducive to spreading symptoms.

In summary, the three conditions necessary for the spread of mental symptoms are as follows: (1) a primary symptomatic “leader”; (2) emotionally bonded followers, and (3) an environment that facilitates transmission. With the convergence of all three, we have a public health crisis arising from the unmitigated psychic contagion that is the product of allowing a mentally impaired individual not only to spend 4 years in an influential office but also to continue to use that influence to regain his bully pulpit and to try to return to that office (Safi and Greve 2023). Because psychic contagion does not require physical exposure but only psychic drives, via the emotional vectors of “mass” media and “viral” social media, it may be even more contagious than an ordinary infectious disease (Huang et al. 2022).

4 Effects of Contagion

The actual observed effects are staggering. For example, before Donald Trump, could we have imagined a mediascape of the level of lying that we see today? Could we have conceived of a US Congress being taken over by those who planned and participated in the 6 January attempted coup d’état? Could we have fathomed a health crisis so mismanaged as to incur almost 1.2 million American deaths at this writing, not to mention multifold that number worldwide? Could we have foreseen the current level of climate disasters, after unprecedented rollbacks of regulations? Could we have imagined the nuclear perils of today, after unprecedented accelerations of a nuclear arms race? Could we have anticipated the current collapse of industries and institutions, as well as democracy itself? Certainly, Donald Trump is not the only cause, but we can be certain that many global crises were made many times worse by the cultural shift that he enabled.

Viewing years of a lack of accountability as success, furthermore, has spread the “contagion” not just throughout the USA but also abroad: countries in Asia, the Middle East, South America, and even Canada and Europe, have seen not only imitative mass shootings in the name of racism or sexism, but Fox News-like “news” programs, the election of Trump-like personalities in multiple countries, a replica coup d’état in Brazil, and an overhaul of the judiciary to avoid prosecutions in Israel. Turkey and Russia have cracked down on reporters, jailing several, having passed laws that explicitly use the phrase “fake news” (Brandom 2023). Having dangerous and troubled personalities in leadership positions has the effect of proliferating themselves: through imitators, surrogates, protégés, and novel institutional creations, from the national and international levels to the local and regional. Spreading beyond politics to include most visibly cable “Talk TV” and social media, the very nature of public discourse has changed.

5 Solutions

What intervention is possible when a psychic contagion has turned into a psychic pandemic? Just like any other contagious disease, prevention is far more effective than intervention after spread. Successful prevention requires population-level interventions (WHO, United Nations Office on Drugs and Crime, and United Nations Development Programme 2014) and what is relevant but conspicuously missing is the application of psychological principles to social systems, institutions, and cultures, including political systems.

Clinical experience and scientific literature illustrate that, when contact with the inducing individual is removed, the shared symptoms usually subside as dramatically as they have appeared (Shimizu et al. 2007). We can prevent epidemics from occurring in the first place by screening candidates for mental impairment before they take office (keeping in mind that “fitness” is different from “mental illness,” which by itself does not bar a candidate from office). Once they are in power, there must be an effective means of removing them if they are found to be unfit (Rogan 2019). Further, we can protect ourselves and democracy by promoting public mental health and education about psychological principles. Finally, we must remove environmental mental “toxins” that include propaganda, thought reform, and the social engineering that results from social media (Pacepa and Rychlak 2013).

In terms of Donald Trump, it was revealed only after he left office that White House Chief of Staff John Kelly had secretly purchased and consulted the book, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President (Lee 2017a), when it was first published. He used it as a guide (Pengelly 2022) and an “owner’s manual” (Green 2022) for how to control and contain a man he, too, realized was far more dangerous than he initially assumed. He even used some of the key concepts in the book to intervene to stop Donald Trump from ordering the use of nuclear weapons against North Korea (Shabad 2023). However, humanity came far too close to dangerous perils, and averting catastrophe cannot rely solely on the cognizance and scruples of a those who happen to be in the orbit of the primary offender. Furthermore, keeping the public largely in the dark about the mental unfitness of its own elected leader makes it far too likely that these dangerous perils will repeat.

Global healing requires a complex multidisciplinary process involving multiple tracks: education, strengthening democratic institutions, creating a more just society, spreading a nonviolent culture, nurturing community life, implementing science, fostering creativity via art, etc. All these, at the same time, promote societal mental health. Although mental health principles are highlighted here, complex sociopolitical problems require an interdisciplinary collaboration between mental health experts, anthropologists, sociologists, political scientists, and historians; a robust psychological discourse about the psychodynamics that are at play in larger society is a necessary component (Weare 2002). Social psychological and psychoanalytic knowledge and understanding happen to be critical at this time (Fingar 2020), and experts of these fields would do well to bring their voices to the public forum and to share their knowledge, as one of the most pressing emergencies of these times—urgent enough to be existential—may be the collective mental health crisis.

Tribute A special tribute goes to Dr. Hans Werbik, who made this essay a part of his last political will. He was extremely prescient in warning, in early 2021, that Donald Trump would reemerge as a threat to American politics and the World Order. His organizing a conference devoted to this topic titled, “Truth and Lies in Politics” at Sigmund-Freud-PrivatUniversität Wien, as his last gesture of academic and societal contribution speaks volumes of the countervailing legacy he leaves these perilous times. I would also like to acknowledge Dr. Lars Allolio-Näcke, who assiduously took on the baton, and without whom neither the conference nor the upcoming publication, Trump Contagion: The More Dangerous Case of Donald Trump, would have been possible.

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